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Q&A with Women’s Health Physio, Jenny Constable

Jenny Constable is a Women’s Health Physiotherapist at Six Physio. We spoke to her to learn more about postnatal physio check ups, find out why they are important and what women need to look out for.

Jenny will be speaking at Pachamama’s upcoming pop ups on 25th Jan, 1st Feb and 8th Feb, addressing subjects including postnatal care regarding pelvic floor, abdominals and sex. For more information on our events and how to book, click here.

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What can women expect when they book their first appointment with you, post-birth?

I always start by asking about their birth history to find out if they’ve had a vaginal birth or a C-section. I find out whether they are breastfeeding, as that has an implication for returning to exercise. We then go through any aches and pains that they have, and talk about their bladder and bowl movements…the nitty gritty stuff. The question that I always ask, which I genuinely never expect to be answered with a yes is: have they returned to sex? I ask that as it helps to know what their expectations are in terms of returning to sex, and I can help alleviate any problems or concerns they have with that.

I then tend to go through what exercise they’ve done pre-pregnancy and during pregnancy, and whether they are doing anything now or what their goals are. This ranges from women who just want to do a class, to others who want to feel more fit; then there are the more extreme cases when a woman already has a date in the diary for her next run.

I would then look at their body, starting with their posture; posture is key. Mothers have gone from nine months of being in a pregnancy posture and they have a tendency to stay in that position which can really impact their tummies.

Once I’ve looked at posture, I will look at that abdominal muscle separation by having them lie down and having a feel of their tummy. At Six Physio we use a real-time ultrasound machine which is exactly the same machine that looks at babies, but I’m looking at stomach muscles to show me if a woman is working her inner core stomach muscles properly. I find a lot of women will grip with their obliques which creates a flat belly with a bulge below the belly button, that then a lot of women work even harder to try to get rid of, which only makes it worse.

Then, if the woman allows it, I will move onto a vaginal assessment, where I’ll ask them to undress from the waist down, cover them in a towel for modesty, to look at them doing a pelvic floor squeeze. I will also look at their stitches if they’ve had a vaginal birth to see for any tears, and potentially have a feel around those muscles to feel if there’s any pain on the outside. Then, with a gloved hand and lots of lubricant, I will go inside the vagina and feel for muscle strength as well as any discomfort.

It’s just like any other routine physio assessment, it’s just that the muscles we’re looking at are harder to access without getting up close and personal!

And how long does that assessment typically take?

That all happens in a one hour session. At the end of the session I’ll go through a couple of exercises – the do’s and don’t’s. A typical one is seeing if they are able to do a double table top (lying down on your back with both legs lifted an a table top position) to check whether they can do this whilst keeping good control of their tummy. If they can’t I can let them know that they can attend their Pilates class, but mustn’t do the double table top yet. It’s about making sure women have that control over their body and knowing what to look out for.

Have you found that there is a popular goal that women are working towards post-birth?

Everyone’s got different goals, but overall I think that women just want to feel like they are doing the right thing and that they are not doing any harm to their bodies.

Are there any common misconceptions that women have about their bodies after birth?

The main misconception, I think, is that women think they should snap back after having a baby. I think that’s because they’re not told much about their post-pregnancy body in their antenatal classes or they see celebrities in the media that have just had a baby and are wearing a tight skimpy dress.

Another misconception is that women think that as soon as they’ve had their six week postnatal check with their GP, they can go straight into running. Generally from what I’ve seen, I would say they can’t.

What would you say is the most important part of your body that you need to be looking after once you’ve given birth?

That’s a tough one! It all works together so it’s hard to pick out just one part, but I’d say your pelvic floor. We know that if you’ve got a pelvic floor that’s functioning nicely, i.e. it can contract and relax, it isn’t painful and it’s strong, that in turn leads you to doing more intense exercise more comfortably.

And what’s the best way to look after your pelvic floor?

Coming in to see a physio of course! We would check that you’re doing your pelvic floor exercises correctly and measure how strong it is.

Then once you’re doing your exercises it’s things like avoiding constipation. Straining can put a lot of pressure on your pelvic floor, so ensuring you’re getting enough fruit and fibre.

Also making sure you poo in the right position. You can do this by making sure your knees are above your hips. If you have a small stool at home, just pop it under your feet when you’re on the toilet.

Avoiding heavy lifting is another way to best look after your pelvic floor. This can be very difficult when you’re a mum, especially if you have a newborn and a toddler, so it’s about seeking advice on when to lift and how by looking at different lifting techniques.

We’re seeing a few fem-tech products that are on the market, for example the Elvie Trainer, which helps strengthen your pelvic floor at home. Would you recommend using those?

There’s lots of things on the market, all varying in different price ranges. The Elvie, for example, is good for what we call ‘bio feedback’, which is basically giving you information on whether you’re squeezing the right muscles. The device can detect pressure and it’s been very well designed in that it usually tells you if you’re doing the wrong thing. It’s a small, wireless device that goes inside and connects to an app on your phone via bluetooth.

The Elvie Trainer is on the more expensive end; there are products like The Educator which has an applicator and is little bit more fiddly, but a lot cheaper.

At the end of the day if you’re doing the correct technique when you squeeze with or without these contraptions, you will get the same result.

Typically, how long do you need to do these kinds of exercise before you start seeing progress?

Any muscle in the body takes eight weeks to get bigger, and normally the guidelines say doing pelvic floor for three months, three times a day should give you enough time to see a progression in that strength.

We’ve focused a lot on postnatal recovery, what are some of your top tips for someone who is pregnant?

I think it’s knowing that there are different educational classes out there that give different advice when it comes to the antenatal and postnatal period. Some are very focused on the labour, breastfeeding and baby care, but don’t talk a lot about looking after the mother and getting her body ready. So I think it’s important that when you’re investigating which antenatal classes to do, just to be mindful of what they’re talking about.

I see so many women who come in with an element of a prolapse – which is when the vaginal wall gets a bit soft and sometimes the bladder or the bowel push into it. It’s quite common – around 50% of women at some point in their life will have a prolapse – but it can be prevented through education.

A lot of the women I see who have a prolapse tell me that they were never told that could happen after having a baby. Knowledge is power. Women should be told these things beforehand so that they are aware of what could happen if they don’t look after themselves properly.

Unfortunately, I think there is a normalisation of the problems you can have after having a baby. For example, you can see an advert about wearing liners because you’re leaking and that will lead you to think that it’s ok, it’s an ‘oops’ moment and it’s fine to do that. When actually it’s not fine. It’s common, but it’s not normal. And we need a lot more education around all of this.

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Jenny Constable is Women’s Health Physiotherapist at Six Physio. She will be speaking at Pachamama’s upcoming pop ups on 25th Jan, 1st Feb and 8th Feb, addressing subjects including postnatal care regarding pelvic floor, abdominals and sex. For more information on our events and how to book, click here.